Hardship letter for a medical bill.
Tell the hospital in writing that you cannot pay, and ask it to reduce or write off the bill. The letter asks for a financial assistance review first, then a lower balance or a plan you can keep.
Last updated .
When to use it
- You cannot pay a hospital or doctor's bill in full, now or soon.
- Your income dropped, or medical bills take up much of what you earn.
- You want the hospital to look at your situation before the account goes to collections.
The letter
Highlighted words in brackets are blanks. Replace each one with your own details.
[Today's date]
[Hospital or provider name] Billing Office [Billing office address]
Re: Request for help with a medical bill because of financial hardship Patient: [Patient's full name] Account number: [Account number on the bill]
Dear Billing Office,
I am writing about the balance of [Balance on the bill] on the account above. I cannot pay it in full because of financial hardship. [What happened, in one or two sentences]
My household has [Number of people in your household] people. Our total income before taxes is about [Household income per month, before taxes] a month. I have attached proof of our income.
I am asking you to:
1. Review this account under your financial assistance policy. If you need an application, please send it to me. 2. Reduce or write off the balance because of my financial hardship. 3. If a balance remains, agree to a payment plan of [Amount you can pay each month] a month with no interest.
While you review this request, please hold the account. Please do not send it to a collection agency or report it to a credit bureau.
Please send me your decision in writing.
Thank you,
[Your full name] [Your mailing address] [Your phone number]
How to send it
- Ask for the financial assistance application first. Call the billing office or look on the hospital's website. If the hospital has a financial assistance policy, send the completed application with this letter, using our cover letter. Nonprofit hospitals must have a written policy for emergency and medically necessary care, and federal law sets no income limit: each hospital sets its own Source 1.
- Fill in every blank. Explain what changed in plain words: a job loss, an illness, a large bill, a new baby. You do not have to share more than you are comfortable with.
- Attach proof of income. Pay stubs, a benefits letter or a tax return are the usual proof. Send copies, never the originals.
- Send it in a way you can prove. Use certified mail with a return receipt, the patient portal, or hand it in and ask for a dated receipt. Keep a copy of everything.
- Send it soon. A nonprofit hospital must accept financial assistance applications for at least 240 days (IRS, published July 2, 2026) after the first bill sent after you leave. It must also wait at least 120 days (IRS, published July 2, 2026) after that bill before it takes serious collection steps, such as reporting the debt to a credit bureau or suing Source 2.
What happens next
The hospital may approve your request, offer a smaller discount, ask for more papers or say no. Answer any request for papers quickly and keep a note of the date.
Once a nonprofit hospital has your complete financial assistance application, it must stop extraordinary collection actions and decide. If you qualify, it must refund what you already paid above what you owe, unless the difference is less than $5 (IRS, published July 2, 2026), and take reasonable steps to undo collection actions Source 2.
Get the decision in writing. If the hospital says no, ask why, ask for a payment plan you can keep, and use our phone script. Our guide to medical debt forgiveness lists other options.
Next step
Medical debt forgiveness: what it is and where it comes from
If you need help with your own situation, these can help:
LawHelp.org lists free legal aid near you.
Your state attorney general takes complaints about medical bills and debt collectors.
The CFPB complaint portal takes complaints about debt collectors and credit reports.
The hospital's financial assistance office can review your bill and tell you what it offers.
Sources
Note 1 IRS, "Financial Assistance Policy and Emergency Medical Care Policy - Section 501(r)(4)". Published July 3, 2026. Last checked November 2, 2026.
Note 2 IRS, "Billing and Collections - Section 501(r)(6)". Published July 2, 2026. Last checked November 2, 2026.
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